INDEPENDENT STUDY PROJECT
Background and Analysis
About Argentina
Thinking of Argentina might bring images to mind of Che Guevara, the Argentine Marxist revolutionary, or Eva Perón, the famous and influential First Lady of Argentina in the mid-1900s. However, Argentina derives its name from the hopes of mid-1500s Spanish explorers of finding silver, or argentum in Latin. While the Spanish have had a heavy influence on the history world’s 8th largest country, Argentina’s identity is something of its own. It was formed through a fusion of native cultural landscapes, European colonial influences, and internal political conflicts, to name only a few contributors (Lonely Planet).
General Facts (CIA World Factbook):
- Population: 43,886,748
- Languages: Spanish (official), Italian, English, German, French, indigenous (Mapudungun, Quechua)
- Religions: Roman Catholic (92%) Protestant (2%,) Jewish (2%), other (4%)
- Ethnic groups: white (97%), mestizo/Amerindian/other (3%)
- Currency: Argentine Peso
- Independence Day: 9 July 1816
- Literacy Rate: 98%
- Birth rate: 17 births/1000 population
- Death rate: 7.5 deaths/1000 population
- Life expectancy at birth: 77.1 years
- Government type: presidential republic; executive, legislative, and judicial branches
- Unemployment rate: 8%
- GDP (purchasing power parity): $879.4 billion
- Public debt: 53.8% of GDP
History (Encyclopedia Britannica)
By the end of the 16th century, the Spaniards had established the settlements of Buenos Aires, Córdoba, Salta, and Tucumán. Córdoba would develop as an important educational center and Buenos Aires would come to the forefront as a booming trade city. Diverse ways of life evolved and coexisted together in the Río de Plata (river of silver) territories. In the late 18th century, the legendary gauchos (the South American counterpart to our cowboy) roamed the pampas in the heartland of Argentina. However, after 300 years of Spanish rule, the criollos (Argentine-born colonists) grew frustrated and declared independence under the leadership of General José de San Martín. The Spanish-established provinces that remained after the revolution were highly divided. The consequent internal political struggle between the Federalists, demanding provincial autonomy, and Centralists, asserting the central authority of Buenos Aires, took decades to resolve.
In the early to mid-19th century, Juan Manuel de Rosas came to power as a federalist, but his policies centralized power in Buenos Aires. His extremism and violent methods led to his removal in 1852 by Justo José de Urquiza, who then drew up Argentina’s first Constitution and became the republic’s first president. His successors ushered in a golden age by building up the new country’s infrastructure and opening up the Patagonia region to settlement. However, the country could not keep up with high rate of immigration and labor unrest grew, leading to an economic crisis known as the Great Slump.
In the latter half of the 19th century, Argentina saw the rise of Juan Perón, founder of the Peronism movement, and who, in his terms as president, established policies that led Argentina towards industrialism and promoted state economic intervention designed to give benefits to the working class. However, in later years, Argentina plunged into military rule. Under the leadership of Jorge Rafaél Videla, the Dirty War (La Guerra Sucia) ravaged the country. Democracy was not to be restored until after Argentina’s defeat in the Falklands Islands War against Great Britain. After an extended period of economic turmoil that followed, Néstor Kirchner was elected to the presidency in 2003, and helped to stabilize the Argentine economy. His wife, Cristina Fernández de Kirchner went on to become Argentina’s first elected female president. In 2015, center-right mayor of Buenos Aires, Mauricio Macri replaced Fernández de Kirchner. In recent years, he has been successful in loosening trade regulations and in negotiations to restructure Argentina’s large national debt.
Argentine Culture and Society (Maps of World)
Argentine culture includes the tango, a deep love for fútbol, and elements of the romanticized gaucho lifestyle. Celebrations and festivals revolve around the church, nationalistic pride, and European influences. In January, Cordoba hosts The National Festival of Folklore, a 9-day celebration of Argentine folk tradition with costumes, dancing, and music. The heavy influence of Roman Catholicism imbues Argentine society and government with conservative values. Family is very important and often families will get together for parillas (barbeques). A ubiquitous social ritual is the sharing of maté, a tea made from dried yerba leaves. Not surprisingly, Argentina’s diverse cuisine is reflective of its diverse culture. Common dishes include asado and snacks such as dulce de leche and empanadas.
Impact on Service
Since my service with Child Family Health International centers on health policy, I think being aware of Argentina’s political history will be beneficial to putting my service in this broader context. In addition, I think that without at least a general knowledge of the Argentinian government as it exists today will no doubt help me better understand the issues important to the Argentine people and the specific communities that I will work with during my 9 weeks. As I’ll be staying in the culturally-rich and lively city of Cordoba, I’m also very much looking forward to learning more about and immersing myself in Argentine urban culture.
Argentina’s Healthcare System (WHO)
Argentina is a middle-income Latin American country and spends a remarkable 8% of its GDP on the health of its citizens. Like a large portion of other Latin American countries, Argentina has established a universal healthcare system. The goal of such a system is to guarantee access to medical care for all, regardless of one’s ability to pay. Until the economic crises of the late 1900s and early 2000s, this was a point of pride for many Argentines. However, many current health indicators such as maternal mortality and infant mortality are not what they should be. Furthermore, there lies a huge disparity between health outcomes between provinces.
The country’s healthcare system is split into the three very fragmented sectors: the public, private, and social security (obras sociales) sectors. Each provincial government runs the public sector. The public system covers all citizens regardless of their financial situation and is funded by taxes and payments by social security beneficiaries that use public health centers. Each province also has an obras sociales system run by the Argentine worker’s unions. This sector covers people with formal jobs, retirees, and their families. The private sector includes private providers offering services and all those with private health insurance. People with more financial resources can afford to be covered by Empresas de Medicina Prepagadas (Private Medicine Companies).
Primary care is at the core of Argentina’s healthcare system. The Primary Care Health Centers (PCHCs) are the first and regular point of contact for medical care and function as the keystone to Argentina’s healthcare system. Primary care also covers a huge range of healthcare issues and a wide range of socioeconomic and geographic demographics. As per the Alma-Ata Declaration of 1978, primary healthcare oriented systems have been shown to reduce the negative impact of social inequalities on health. Accordingly, Argentina is investing considerably in improving the quality of accessible primary care.
In the last few decades, various health policy reforms have been implemented to address the deteriorating operating efficiency and distributive equity of the public and OS sectors. Presidential directives have been issued with the objective of improving accessibility and quality of medical care, with special attention given towards vulnerable populations. With respect to the public sector, there has been administrative decentralization of national hospitals to those with provincial and municipal jurisdictions. With regards to the national OS sector, a measure has been taken to create self-managed hospitals that can generate resources through providing medical services to both those with private and OS health coverage. Additional deregulation of the OS sector has been put into effect to promote free choice and increase competition.
These policy reforms and their effects have been a topic of debate. Instead of focusing on improving the situation of the poor or of groups with limited healthcare access, these policies have been characterized as only improving cost-effectiveness while still propagating the divided nature of the current system. Self-managed hospitals were only able to increase their budgets slightly, and competition between social health insurance funds was ineffective in reducing sector fragmentation. Nevertheless, Argentina’s ultimate yet elusive-proving goal continues to be in creating a functioning universal health insurance system that provides equal access to common benefits while considerably reducing out-of-pocket expenditure.
Breaking News
Country-specific
Argentine Ex-President Faces Trial in $3.5 Billion Fraud Case
Summary
This article from the New York Times revealed that, in March of this year, an Argentine judge had ordered former President Fernández de Kirchner to stand trial on charges of defrauding the government. She is charged with engineering a plan to sell the Argentine central bank’s dollar futures at below-market rates, which has cost the government several billion dollars at the current exchange rate. This is not the first political scandal that Mrs. Kirchner has faced after leaving office. Last year she was indicted on fraud and corruption charges. In addition, there is an on-going investigation into her alleged dealings with Iran related to the 1994 bombing of a Jewish center in Buenos Aires. The article included that the former president has consistently denied all allegations against her, and has claimed that she is being politically persecuted by current president and political opponent, Mauricio Macri.
Reflection
This article provides a sharp insight into the politically-rocky environment of current day Argentina. I had read a little beforehand about Fernández de Kirchner’s difficult tenure as president, but she seems to be enveloped in many alleged political scandals, even after leaving office. It also provides some context into why some Argentines might be a little distrustful of their government and the importance of local grassroots organizations in rebuilding that lost trust. Given this politically charged environment, I think it is best to steer clear of any such arguments during my service in Argentina. These situations might prove to be counter-effective to building constructive relationships with community partners and local residents.
‘A runaway crisis’: Argentina activists aid shanty towns state has left behind
Summary
While President Macri had promised to eliminate poverty with a ‘zero poverty’ pledge upon taking office in 2015, approximately 1.5 million more Argentinians fell below the poverty line in 2016. A report published by the Social Debt Observatory of Catholic University states that now there are about 13 million Argentines in poverty; this number is an astounding 32.9% of Argentina’s population. This article by The Guardian chronicles the efforts of an activist group called Corriente Villera that brings medical care to the poorest areas of Buenos Aires. These ‘shanty towns’ have been neglected by state workers bringing social services, who are afraid of the crime rampant in these areas and don’t know how to navigate them. Marina Joski, the leader of Corriente Villera, grew up near Villa 1-11-14 the largest shanty town in the city of Buenos Aires. She had the idea of buying secondhand ambulances to serve these neglected areas, and now her group also helps organize soup kitchens, trash clean-ups, and the removal of stagnant ponds that become the breeding grounds for mosquitoes carrying dengue and Zika.
Reflection
This article places the existing unequal access to healthcare in an economic context. It was eye-opening to learn that, despite the efforts of President Macri, such shanty towns exist and are growing in size. I think this article also speaks to the importance of knowledge of local community culture. Like Joski says in the article, without the ability to navigate the cultural landscape of these shanty towns, state workers can’t reach the citizens that most desperately need medical care. This same principle can be applied to my service, and speaks to the importance of this Independent Study Project and endeavoring to learn as much as I can about the Argentine people before I embark on my trip. Indeed, this is especially true since I will be joining the state workers referenced in the article as a part of the Ministry of Health mobile clinics.
Issue-specific
Aborto no punible: suspensión del protocolo no evitó los casos
Summary
This article is from La Voz del Interior, a daily Argentinian newspaper based in Córdoba. The article focused on the issue of non-punishable abortions, the practice of which was suspended in April 2012 in Cordoba by order of a provincial court. The Non-Punishable Abortion Protocol, put in effect by the Ministry of the Health of the Nation, regulates the care of pregnant women, whose pregnancy is due to rape or is a danger to their lives. All other abortion cases are illegal in Argentina. There are still health centers such as La Maternidad Nacional and municipal dispensaries that aren’t affected by the provincial suspension of the protocol and continue to accept requests for non-punishable abortions. The suspension of the protocol has pushed some women to request abortions in an unsafe manner even when they are entitled to safe abortion in the cases that are allowed by the law. There have been demonstrations in Córdoba in support of non-punishable abortion, and eventually, the Superior Tribunal of Justice must decide whether or not to overrule the provincial court decision.
Reflection
This article speaks to the close relationship between the Catholic Church and the Argentinian government. The influence of the Church can be seen in healthcare policy and in maternal rights. While the feminism movement is growing and Argentina’s boasts having a female elected president, it is readily apparent that women are still struggling to obtain equal rights. After speaking to past Loewenstern fellows, it was interesting to learn that participating in public demonstrations of the type mentioned in the article is much more common in Argentine society than in American society. It serves as an important line of communication between the Argentine people and their government. Another conduit between the public and the government is the Ministry of Health. Specifically, the Ministry of Health serves in a crucial role of education. I think that this function is especially important in poor areas where basic health-related knowledge and health policy awareness (as referenced in the article) is lacking. Thus, by supporting its operations and public health campaigns, I feel as I can make a lasting difference with my service.
Aseguran que esta semana repondrán las vacunas contra el meningococo
Summary
This article from La Voz del Interior announced that after a month of shortage of the new meningococcus vaccine in Córdoba, the Ministry of Health of the Nation has said that distribution of doses will resume that same week. The new meningococcal vaccine was incorporated into the national immunization schedule last January to better protect infants from the severe bacterial infection, but doses had run out by mid-February in Córdoba. The Ministry attributed the interruption in the vaccine supply to “custom clearance problems” that have now been resolved. The article added that the country’s flu vaccination campaign would start in the first days of April.
Reflection
This article provides some insight into a recent public health issue that the Ministry of Health has been dealing with. The creation of national yearly immunization schedules and then the distribution of necessary vaccines are some of its most important roles. Being aware of at least of few current challenges for the Ministry before I begin my service will prove to be invaluable for placing my work in a broader and historical context. Additionally, having worked in an immunobiology lab specializing in novel vaccine design during my time at Rice, I have come to see immunization as essential preventative health measure. And after reading this article, I am even more excited to learn about the logistics of vaccine distribution and public campaigning at the national and local level.
Faculty and Community Connection
Faculty Connection
I was thrilled to have the opportunity to reconnect with a Spanish professor, Dr. Lujan Stasevicius, with whom I took a class last semester. Profa. Lujan grew up in a city called Bahía Blanca, located in the province of Buenos Aires, where she earned a teaching degree from a public university before coming to the U.S. for higher education. She was more than willing to meet with me to share her own unique perspective on Argentine life, politics, and culture.
Profa. Lujan first described some of the cultural norms of Argentine life. She said that, in general, the Argentines are a warm, open, and friendly people. She explained that there is a lot of cultural penetration from the United States and that I would encounter many English speakers, especially since I will be serving in the university town of Córdoba. Profa. advised me to be flexible and understanding of the different daily routine of Argentine life that I will be sure to encounter. While Córdoba is transitioning to American work hours (like Buenos Aires), many people take mid-afternoon breaks from 1 to 3 pm. When I asked her about potentially offensive things to be aware of that might be common in American culture, I was surprised to hear her say that the locals are more likely to offend me. She explained that people poke fun at everything and at times may seem a bit blunt. They tend not to consider what they say as potentially offensive. However, she did say that Argentine society is very politically active but divided. She referred to this division as “la grieta,” a social divide between those blindly for kirchernerismo (the policies of Kircher and Fernandez de Kirchner) and those against kirchnerismo (supporters of macrismo – the policies of Macri).
From the topic of government, we then transitioned to education and healthcare policy. Profa. Lujan explained that there exist both public and private universities, similar to the U.S. but that public universities are free and open to anyone that wants to learn. She added that Córdoba has the country’s very first public university and is also a hot spot for medical training. Profa. then went on to describe Argentina’s universal healthcare system with a sense of pride. She lauded the efforts of mobile clinics that go to areas without hospitals nearby or where people can’t afford the time to go the hospital and wait in long lines. When I asked her about these still existing gaps in access to medical care, she explained that public hospitals often don’t have the best budgets and that Argentina’s difficult financial situation is putting a further strain on them. She said that mobile clinics are helping to alleviate this problem by helping to raise awareness about issues such as women’s health. She advised me to keep an open mind and to be understanding that health-related things that may seem obvious to people in the United States may not be so obvious to those in underserved areas. Profa. Lujan cited a couple stories she had heard from some of her friends that worked in a public hospital. She had heard of a woman who put a birth control pill in her maté to share with a friend, thinking that they would both be protected. Another patient kept asking for his doctor to read his prescription aloud, which confused the doctor until she realized that he could not read.
I think that the main takeaways from our conversation were to: (a) remain flexible when I encounter cultural differences and to (b) keep an open mind towards local Argentine attitudes toward health and politics. If I ever find myself in the midst of a politically charged conversation, I will be sure to tread with caution. Nevertheless, I am very much looking forward to immersing myself in Argentine culture, but this transition will obviously come with situations in which I will have to adapt. For example, I prefer punctuality (a by-product of American cultural norms), but from what Profa. said, it seems that Argentines take a very relaxed approach to being on-time. Additionally, because I will be working in a clinical setting abroad, I will inevitably encounter patient cases that I would never see in the United States. In these moments, I have to remember to be especially wary of my expectations of assumed basic health knowledge as well as assumed cultural practices in the context of the patient-doctor relationship.
Community Partner Connection
For my Loewenstern Fellowship, I will be interning with an organization called Child Family Health International. Child Family Health International (CFHI) is an NGO in Special Consultative Status with the ECOSOC of the United Nations. CFHI’s mission is to provide community-based Global Health Education Programs in a way that “fosters reciprocal partnerships and empowerment in local communities, transforming perspectives about self, healing and global citizenship” (CFHI). Accordingly, CFHI uses an asset-based community engagement model that embeds interns in the local community educational narrative. In Córdoba, CFHI partners with the Argentine State Ministry of Health, where I will be conducting my service. The State Ministry of Health is in charge of running federal and state public health outreach and education programs while also implementing changes to public health policy. At the national level, it advises and works with the President and the Chief of the Cabinet of Ministers in reforming public health policy. At the local level, it works administratively with hospitals to align budgets and serves as the bridge between national policy and the public. In the latter capacity, it runs public campaigns to educate citizens on health issues such as healthy living and nutrition, mammograms, and vaccinations. The Ministry is also responsible for reaching out to Argentina’s most vulnerable populations and working to understand region-specific health and disease outcomes.
With the State Ministry of Health, I will be volunteering with their mobile clinic operations as well as assisting in their education and outreach programs at secondary city hospitals. The mobile clinics are responsible for delivering basic medical care in areas that have limited access. They provide services such as blood pressure screening, vaccines, mammograms and nutrition counseling. I anticipate that I will be mostly observing the medical professionals and perhaps also obtaining medical history information under supervision. In addition, I will be working with the Social Services Department within various secondary hospitals in Córdoba to assist in programs such as monthly diabetes education groups, a free diabetes medication program, sexual health education, and healthy eating campaigns (Ministerio de Salud). Upon my return to the U.S., I think my primary role will shift more towards education and advocacy. As a university student, I have the unique opportunity of sharing my experiences with my fellow classmates. In this capacity, I can increase visibility of the health disparities that exist within Argentina’s healthcare system and of global health issues in general.
ISP Reflection
My initial interest in the Loewenstern Fellowship emerged from a desire to immerse myself in another culture while actively engaging in hands-on service. Service has been such an important part of my life up to this point (especially during my Rice career) that when I learned about the Loewenstern, I knew immediately that this was an opportunity that I wanted to pursue. Now less than two months away from embarking on my service trip, I am overwhelmed with excitement and deep feeling of gratitude.
My motivation in choosing this project with Child Family Health International came from a deep interest in medicine and a recently sparked interest in health policy. I thought that the best way to increase my understanding of health policy in the U.S. was to place them in a global context. I also wanted to be able to better compare policy differences and the resulting quality of healthcare in a South American country, as I am currently debating whether or not I want to pursue a Master’s of Public Health degree.
With the completion of this independent study project, I realize that there is still so much I have yet to learn about this vast country. Specifically, I want to learn more about the relationship between government and daily local life. How do these two narratives differ when it comes to topics such as public health and economic recovery? To fully understand this issue, I think that I will need to be in-country and get to know local perspectives. In addition, I want to learn more about how each provincial Ministry of Health regulates health infrastructure. What are the challenges that the Ministries face that result in such a variety of health outcomes province to province? I think that more research in this area before my trip would equip me with a greater degree of fluency in Argentina’s healthcare system. In the coming weeks, I want to continue dialogue with CFHI to learn more about current health issues that I will be working on and thus get the most out of my Loewenstern experience.
Appendix
Works Cited
Argentina. (n.d.). History. Retrieved April 05, 2017 from
http://www.lonelyplanet.com/argentina/history?lpaffil=lp-affiliates
The World Factbook: Argentina. (n.d.). Central Intelligence Agency. Retrieved April 05, 2017 from
https://www.cia.gov/library/publications/the-world-factbook/geos/ar.html
Calvert, P. A., & Eidt, R. C. (2016, September 26). Argentina. Retrieved April 05, 2017, from https://www.britannica.com/place/Argentina
Argentina Culture and Traditions. (n.d.). Retrieved April 05, 2017, from http://www.mapsofworld.com/argentina/culture-and-traditions.html
Overview of Argentina Health Care Financing System. (n.d.). Health Financing in Argentina: An Empirical Study of Health Care Expenditure and Utilization. Retrieved March 17, 2014, from
http://www.who.int/health_financing/documents/argentina_cavagnero.pdf
Breaking News Article Links
https://www.theguardian.com/world/2017/mar/26/argentina-poverty-crisis-towns-activism
http://www.lavoz.com.ar/ciudadanos/aborto-no-punible-suspension-del-protocolo-no-evito-los-casos